Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explore...Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.展开更多
目的探讨微伏级T波电交替(MTWA)技术联合血清微小RNA-130a(miR-130a)对心脏再同步化治疗(CRT)后慢性心力衰竭(CHF)患者室性心律失常的预测价值。方法前瞻性选取2021年3月至2022年1月郑州大学第一附属医院收治的130例经CRT治疗的CHF患者...目的探讨微伏级T波电交替(MTWA)技术联合血清微小RNA-130a(miR-130a)对心脏再同步化治疗(CRT)后慢性心力衰竭(CHF)患者室性心律失常的预测价值。方法前瞻性选取2021年3月至2022年1月郑州大学第一附属医院收治的130例经CRT治疗的CHF患者,均于CRT前、CRT 6个月后进行MTWA检查和血清miR-130a检测。所有患者均随访12个月,失访7例,根据随访期间是否发生室性心律失常分为发生组26例和未发生组97例,比较两组患者CRT前和CRT 6个月后的MTWA参数、血清miR-130a水平;采用Spearman相关系数法分析MTWA参数、血清miR-130a与CHF患者室性心律失常的相关性;采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析MTWA、血清miR-130a预测CHF患者室性心律失常的价值。结果CRT前、CRT 6个月后发生组V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA、miR-130a均高于未发生组,差异均有统计学意义(P<0.05);Spearman相关系数法分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及miR-130a均与CHF患者室性心律失常发生呈正相关(P<0.05);ROC曲线分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及血清miR-130a联合预测的AUC分别为0.912、0.933(P<0.05)。结论MTWA参数、血清miR-130a与CHF患者室性心律失常存在一定线性关系,CRT治疗前后MTWA参数和血清miR-130a联合预测CHF患者发生室性心律失常具有一定的价值。展开更多
基金the National Natural Science Foundation of China (No. 81470457)the Frontier Technology of Jiangsu Provincial Science and Technology Department (No. BE2016764).
文摘Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.
文摘目的探讨微伏级T波电交替(MTWA)技术联合血清微小RNA-130a(miR-130a)对心脏再同步化治疗(CRT)后慢性心力衰竭(CHF)患者室性心律失常的预测价值。方法前瞻性选取2021年3月至2022年1月郑州大学第一附属医院收治的130例经CRT治疗的CHF患者,均于CRT前、CRT 6个月后进行MTWA检查和血清miR-130a检测。所有患者均随访12个月,失访7例,根据随访期间是否发生室性心律失常分为发生组26例和未发生组97例,比较两组患者CRT前和CRT 6个月后的MTWA参数、血清miR-130a水平;采用Spearman相关系数法分析MTWA参数、血清miR-130a与CHF患者室性心律失常的相关性;采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析MTWA、血清miR-130a预测CHF患者室性心律失常的价值。结果CRT前、CRT 6个月后发生组V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA、miR-130a均高于未发生组,差异均有统计学意义(P<0.05);Spearman相关系数法分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及miR-130a均与CHF患者室性心律失常发生呈正相关(P<0.05);ROC曲线分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及血清miR-130a联合预测的AUC分别为0.912、0.933(P<0.05)。结论MTWA参数、血清miR-130a与CHF患者室性心律失常存在一定线性关系,CRT治疗前后MTWA参数和血清miR-130a联合预测CHF患者发生室性心律失常具有一定的价值。
